Healthcare Unfiltered

Aaron Goodman (@AaronGoodman33), MD, hematologist/oncologist, University of California San Diego, and Jatin Shah (@JatinShahMD), MD, executive vice president and chief medical officer, Karyopharm Therapeutics, join the show for a deep consideration of oncology drug approvals in the context of RCTs, RWE, surrogate endpoints, and outcomes. The larger discussion is framed around Karyopharm’s STORM study of selinexor in refractory multiple myeloma and whether the FDA had enough convincing data to approve the drug. Contention ensues around the findings of Karyopharm's BOSTON study and whether they should be used to justify selinexor as a second-line treatment.

In an enthralling yet informative roundtable discussion, Chadi hosts Saurabh Jha (@RogueRad), MD, radiologist and frequent guest of the show; Vinay Prasad (@VPrasadMDMPH), MD, MPH, hematologist/oncologist and former guest of the show; and Sally "Loyal Listener"(@barttels2), patient advocate, to breakdown 2020 like only they can. These titans of the MedTwitter world dissect and opine on lessons to be learned from COVID-19 (warts and all), the diminishing space for public discourse and healthy debate, the not-so-subtle censorship of provocative materials in academic journals due to social media backlash, cancel culture and the power of the Twitter mob, and so much more.

Rafael Fonseca (@Rfonsi1), MD, interim director of Mayo Clinic Cancer Center, shares with Chadi his picks for the most clinically applicable multiple myeloma studies coming out of the ASH virtual meeting, including notes on transplantation, frontline therapy, the “belle of the ball” bispecific antibodies, CAR-T therapies, and MRD monitoring.

Laura Lee (@lauraelee), JD, a lawyer by training and journalist in North Carolina, brings her unique perspective to the show to discuss how language used on social media to describe the outcomes of clinical trials and the tolerance of therapies in a patient population can be damaging to patients on an individual level. She expresses some of her larger concerns in the way medical information is displayed and discussed online, including the tone that is used, how quality of life measures fall short in providing value for individual patients, and the lack of compassionate language used in studies that are poorly conducted.

Yousuf Zafar (@yzafar), MD, GI oncologist and associate professor of medicine, Duke University, highlights perspectives that are missing from the “general rubric” of value-based care in oncology, how real-world evidence (RWE) can help augment takeaways from clinical trial data, issues of capturing the patient voice in real-world data and electronic health records, and how the FDA is utilizing RWE for expanding drug indications. Dr. Zafar shares where he sees the intersection between RWE and value-based care existing from a payer perspective as well why he believes the COVID-19 pandemic provides “fertile ground” for the prevalence of RWE.

Alison Bateman-House (@ABatemanHouse), MPH, PhD, medical ethicist at New York University’s School of Medicine, explains the distinction between direct-to-consumer (DTC) advertising of doctors and drugs to that of consumer goods, as well as regulatory and ethical concerns of DTC advertising on the part of hospitals and drugs. Chadi and Dr. Bateman-House grapple with questions of whether healthcare is simply a consumer good or if it is something more and whether DTC advertising should be banned in healthcare altogether.

Jill Feldman (@jillfeldman4), lung cancer survivor and advocate, shares her familial history of lung cancer that drove her to advocacy work long before her own diagnosis of EGFR-positive disease, as well as her treatment courses with erlotinib and subsequent SBRT for many years before osimertinib. Jill then describes her “journey” in advocacy, beginning with self-advocacy and the LUNGevity Foundation, independent research advocacy and representing lung cancer patients, and co-founding the EGFR Resisters (@EGFRResisters) – a group of EGFR-positive patients who are resistant to targeted treatment. Her message for clinicians and scientists is to start thinking of patients as partners in research.

Ameet Kini (@AmeetRKini), MD, PhD, hematopathologist, and Patrick Hagan, MD, hematologist/oncologist, both at Loyola University Medical Center, deliberate on the clinical importance of MRD and how clinicians should utilize it, optimal techniques for detecting MRD in various diseases, the gap between academia and the community when it comes to MRD knowledge, the potential of MRD as a surrogate marker, and how to reconcile discordant MRD results from different vendors.

Vincent Rajkumar (@VincentRK), MD, hematologist at the Mayo Clinic (Rochester, MN), shares the distinction between conflicts of interest that guide individual physicians and those that guide entire practices, what types of conflicts should be collected as “material” and which should be disregarded (eg, “transfer of value” payments), issues with disclosure expectations in modern medical research, and an idea to create standards for more appropriate and warranted disclosures. Watch a previous discussion Chadi had with Dr. Rajkumar on conflicts of interest https://www.medscape.com/viewarticle/924320

Chadi facilitates a discussion between three GU oncologists on the latest research and treatment updates in the field. Rana McKay (@DrRanaMcKay), MD, UC San Diego, Petros Grivas (@PGrivasMDPhD), MD, PhD, Fred Hutchinson Cancer Research Center, and Toni Choueiri (@DrChoueiri), MD, Dana-Farber Cancer Institute, debate the practice-changing potential of chosen papers and abstracts presented at ASCO and ESMO, including updated data on the final OS in the PROFOUND trial, context and implications of the JAVELIN trial for bladder cancer, ramifications of the CheckMate 9ER trial for kidney cancer, and more.